POS1206 UNDERSTANDING THE LANDSCAPE OF RHEUMATOID ARTHRITIS (RA) PATIENTS TREATED WITH IL-6 INHIBITORS DURING THE COVID-19 PANDEMIC
Authors: D. Baldock, E. Baynton, A. Kamaruddin
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid Arthritis (RA) is a complex autoimmune disease which affects the joints and various organs 1 and patients may experience frequent and painful flare ups. Besides conventional therapies, multiple bDMARDS are approved to treat RA, including tocilizumab and sarilumab. With IL-6 inhibitors being approved for emergency use to treat critically ill COVID-19 patients, this may influence the treatment paradigms of some RA patient cohorts. Objectives The objective of this study is to observe the landscape of RA patients treated with IL-6 inhibitors during the COVID-19 pandemic period, compared to the pre COVID-19 period. Methods A multi-centre online medical chart review study of patients with RA was conducted between January 2019 – March 2020 (“pre-COVID”) and April 2020 – June 2021 (“during-COVID”) among UK, FR, DE, IT &amp; ES rheumatologists practicing across hospital and private practices. Recruited from a large access panel, physicians were screened for duration of practice in their specialty (3-30 years) and caseload (2 or more RA patients seen in an average week). Participants were asked to complete a 3-part survey online: (1) a doctor demographic questionnaire, (2) a perceptual questionnaire, and (3) patient charts for the next 5 biologic/JAKi receiving RA patients seen following receipt of the survey, which captures patient demographics and treatment history. Descriptive statistics were used to analyse the data. Results For the pre-COVID cohort, 1283 physicians were recruited and collectively reported 6250 RA patients, 754 of which were treated with IL-6 inhibitors for their RA. For the during-COVID cohort, 1279 physicians were recruited and collectively reported 6188 RA patients, 760 of which were treated with IL-6 inhibitors for their RA. 96% of sampled physicians cited access to IL-6 inhibitors in hospital or practice in the during-COVID period, compared to 77% in the pre-COVID period (p&lt;0.01) - this may be linked to the approval of emergency use of IL-6 inhibitors to treat critically ill COVID-19 patients, hence making it more widely available during this period. A larger proportion of reported IL-6 inhibitor patients in the during-COVID cohort had stayed on this drug class for more than 6 months, compared to the pre-COVID cohort (67% vs 62%, p&lt;0.05). Association with high-risk comorbidities, severity of RA at diagnosis and previous therapies received were key areas of differentiation between the two reported patient groups. For the during COVID cohort, IL-6 patients were significantly more likely to be recorded as having concomitant metabolic conditions vs the pre-COVID cohort (72% vs 48%, respectively; p&lt;0.01) and respiratory conditions (4% vs 1%, respectively; p&lt;0.01). Furthermore, reported IL-6 patients from the during COVID cohort were significantly more likely to have their RA classified as ‘severe’ (physician-defined) at the time of diagnosis vs pre-COVID reported IL-6 patients (41% vs 33%, respectively; p&lt;0.01) and were significantly more likely to have switched from previous TNFi/CD20 biosimilar therapy compared to the pre-COVID cohort (16% vs 7%, respectively; p&lt;0.01). Conclusion From the sample surveyed, it appears that high risk comorbidities, severity of RA at diagnosis and type of previous therapy are key differentiating points behind IL-6 usage in RA patients pre vs during the COVID-19 pandemic. With the increasing risk that RA patients may experience severe side effects if infected with COVID-19 2 and guidance to use IL-6 inhibitors in certain patient cohorts during this time, this may explain the patterns seen in our dataset. Further investigation using comparator cohort is warranted. References [1]Yip, Ronald Man Lung FRCP (Edin), FHKCP * ; Yim, Cheuk Wan FRCP, FHKCP † Role of Interleukin 6 Inhibitors in the Management of Rheumatoid Arthritis, JCR: Journal of Clinical Rheumatology: December 24, 2019 - Volume - Issue - doi: 10.1097/RHU.0000000000001293 [2] https://www.rheumatologyadvisor.com/home/rheumatoid-arthritis-advisor/ra-confers-higher-rates-of-covid-affects/ Disclosure of Interests None declared